The disc at risk in athletes: perspectives on operative and nonoperative care

Low back pain is the most common cause of disability in individuals below the age of 45 and the third most common cause of disability overall. Although acute back pain is generally felt to have a high probability of spontaneous resolution, the high recurrence rate of low back pain challenges the notion that resolution of symptoms is accompanied by restitution of function. Athletes who have lumbar spine dysfunction represent a particular challenge to the treating physician due to their high levels of activity and expectation of return to sport. Injuries to the intervertebral disc in the lumbar spine are a particular subset of spine injury. Management of intervertebral disc injuries, which is the focus of this section, is fraught with controversy. Although the majority of intervertebral disc injuries can be treated conservatively, the decision to follow an aggressive conservative versus surgical course in any given athlete must be made on an individual case basis.